Sierra Leone Site Visit Dispensing Feedback

Wellbody Pharmacy Workflow:

• Provider creates medication order in the system. Pharmacy can see the prescription in the current Dispense form.

• Patient comes to the pharmacy and turns in their card

• Pharmacy scans the card and looks up the patient

• The pharmacy clicks on the visit and then clicks on Dispense Medication form

  • The Dispense Medication Form allows you to dispense one medication at a time. If there is something not in stock, they just don’t dispense that drug, but dispense everything else

  • If the medication is not in stock, they tell the patient to try go to another pharmacy

• They would like to add to the Dispense Medication form, the ability to view the Diagnosis so the pharmacy can confirm

• Question for SL pharmacy team: Tracking Dispensed drugs in the ledger that are provided by the government? Do you want to track these in the EMR? Do you need to provide them the ledger or would an export work?

KGH Dispensing:

• Currently the prescriptions are happening on paper. The pharmacy receives a paper prescription.

• If it’s out of stock they will call the clinician to tell them what’s in stock and the clinician will update the prescription with a new medication

• The pharmacist will never update the medication/formulation only the clinician will

• Most of the time (except NCD) the patient will get their vitals taken when they come back to pick up a refill. They will not get another prescription from the clinician

• Medications are dispensed one at a time so if something is not available, they don’t hold up the entire order.

• Pharmacists do change the quantity if they don’t have stock availability, but that’s the only thing they change.

• When a patient gets prescribed a medication with refills, the pharmacy will calculate how many total tablets/capsules they will need over the course of that prescription (i.e. if they take a daily tablet every day for 6 months, they will document they need 180 tablets over the course of the prescription). They will give them the amount they have (either one or two months of pills) and document the Next Refill Date and the total amount remaining to dispense.

• They know how many refills a patient has not because the clinician provides number of refills, but because the clinician will put the Next Review Date (next visit date) and the pharmacy knows they will need medication until their next visit.

  • When a patient is prescribed a medication that is not available, the pharmacy will call the clinician tell them what was prescribed is not available, and tell them what is available. The clinician then changes the prescription and gives it back to the pharmacy.

• For NCD, the pharmacy gives them a list of what is available that week so they know what they can prescribe

• The pharmacy is staffed by both PIH and by Ministry technicians. The ministry drugs cost money and PIH drugs are free.

  • Ministry needs to track the cost of their drugs, but this shouldn’t happen in the EMR. Only the OPD drugs cost money.

• It would be helpful to see Age, Diagnosis and Last Vitals on the Medication Order row where Allergies is

• MCOE will have their own pharmacy, if they come to KGH pharmacy they will send them back, but every once and a while they might dispense the medications from the KGH pharmacy. With Location added as a column to the Active List view they will be able to tell where the medication order came from.

For NCD at KGH:

• Prescriptions will be for 6 months. The patient will get a next pick up date from the pharmacy depending on stock outs. If they only get a 3 month supply they will come back to the pharmacy on the date they say and pick up the additional medication. They will not go back to the NCD clinic until the 6 months date.

Future wishlist

• Want to also track Consumables especially for inpatient

• Want to integrate with OpenBoxes

Non EMR

• In the future would like to keep a registry of locations of medications on shelves so they are easier to find

• Want to display the Active list of Orders on a monitor

Areas where the O3 dispensing conflicts with the SL workflow

1. Medication orders in O3 are dispend as group of drugs, but in SL they dispense each individual drug. If there is a stock out, they dispense all the drugs they have and leave the one that don’t have as not dispensed.

2. Refills are used at KGH and Wellbody, but not in the same way they are in the O3. The clinican prescribes a drug for 6 months instead of 1 month with 5 refills. The longest duration I heard before a new medication order was written was for 6 months. We should make sure the Medication Order in the dispensing app doesn’t Expire before 6 months at a minimum (I think it’s currently set to 90 days)

3. Only clinician changes the formulation or drug, the pharmacy team doesn’t do that now. They just did a retraining of pharmacy staff to ensure they dispense what is prescribed, so it may be contradicting to allow them to change what was prescribed in the system.

4. There are many different states a individual drug in an Order could be in. Each drug in the order could be in different states.

   1. Active - the drug is submitted to the pharmacy but hasn’t been interacted with

   2. In Progress - the drug is being prepared for pick up

   3. Ready for Pick Up - the drug is ready for pick up by the patient

   4. Complete - the drug is dispensed

   5. Partial Dispense - the drug was only partially dispensed (due to limited supply)

   6. Active Refill - the drug has been dispensed, but still has refills to dispense

   7. Stock Out/Paused- the drug can’t be dispensed due to stock out

5. SL tracks some additional fields on their paper dispensing record:

   1. Next Refill Date (manually field)

   2. Quantity remaining when they only partially dispense

6. What pharmacy views from the visit

   1. Next Review/Visit Date

   2. Diagnosis, Last Vitals, Age

7. Ministry drugs vs PIH drugs